CARC 5: The service/treatment is not authorized
Your insurer says no prior authorization was obtained for this service before it was performed.
What this means for your claim
Many plans require pre-approval before certain procedures, specialist visits, or hospitalizations. If authorization wasn't obtained, the claim may be denied or reduced.
What to do next
- 1
Ask your provider if they obtained (or attempted to obtain) prior authorization. Get the authorization number if one exists.
- 2
If your provider failed to get authorization, they may be responsible — ask the billing office directly.
- 3
If the service was urgent or emergent, file an appeal citing the emergency exception rules in your plan documents.
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